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May 23, 1986, Vol 255, No. 20 >
ARTICLE | May 23, 1986

Validation of a Model to Identify Young Patients for Lymph Node Biopsy FREE

Gail B Slap, MD; James L. Connor, MD, PhD; Robert S. Wigton, MD; J. Sanford Schwartz, MD
[+] Author Affiliations

Reprint requests to Section of General Medicine, Hospital of the University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104 (Dr Slap).


JAMA. 1986;255(20):2768-2773. doi:10.1001/jama.1986.03370200070030
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References

A model to identify 9- to 25-year-old patients with malignant or granulomatous lymphadenopathy demonstrated a sensitivity/specificity of 0.95/0.96 in the original sample. This study tests the performance of the model in three new samples (n=34, 87, 46) of young patients with peripheral lymphadenopathy. Patient charts were reviewed for the biopsy diagnosis and for the three variables in the model (lymph node size, recent ear-nose-throat symptoms, and chest roentgenogram). Prevalence rates of malignancy or granuloma in the three samples were 0.71, 0.37, and 0.37. The model's sensitivity/specificity in the three samples were 0.96/1.00, 0.88/0.80, and 0.82/0.83. Receiver operating characteristic curve areas for the model ranged from 0.87 to 0.98, indicating excellent discrimination. Likelihood ratios were calculated for all scores to allow adjustment of the model's predictions for population differences in the prevalence of malignancy or granuloma. We conclude that the model performs well and can help physicians to select those young patients with peripheral lymphadenopathy who should undergo biopsy.

(JAMA 1986;255:2768-2773)

REFERENCES

1 +
Lee YN, Terry R, Lukes RJ:  Lymph node biopsy for diagnosis: A statistical study . J Surg Oncol 1980;;14:53-60.
2 +
Zuelzer WW, Kaplan J:  The child with lymphadenopathy . Semin Hematol 1975;;12:323-334.
3 +
Greenfield S, Jordan C:  The clinical investigation of lymphadenopathy in primary care practice . JAMA 1978;;240:1388-1393.
4 +
Saltzstein SL:  The fate of patients with nondiagnostic lymph node biopsies . Surgery 1965;;58:659-662.
5 +
Sinclair S, Beckman E, Ellman L:  Biopsy of enlarged, superficial lymph nodes . JAMA 1974;; 228:602-603.
6 +
Knight PJ, Mulne AF, Vassy LE:  When is lymph node biopsy indicated in children with enlarged peripheral nodes? Pediatrics 1982;; 69:391-396.
7 +
Luscieti P, Hubschmid TH, Cottier H, et al:  Human lymph node morphology as a function of age and site . J Clin Pathol 1980;;33:454-461.
8 +
Zitelli BJ:  Neck masses in children: Adenopathy and malignant disease Pediatr Clin North Am 1981;;28:813-821.
9 +
Slap GB, Brooks JSJ, Schwartz JS:  When to perform biopsies of enlarged peripheral lymph nodes in young patients . JAMA 1984;;252:1321-1326.
10 +
International Classification of Disease, Ninth Revision, Clinical Modification , Dept of Health and Human Services publication (PHS) 80-1260. Health Care Financing Administration, 1980;, vol 3, pp 110-111.
11 +
Klecka WR:  Discriminant analysis , in Nie NH, Hull CH, Jenkins JG, et al (eds): SPSS: Statistical Package for the Social Sciences , ed 2. New York, McGraw-Hill International Book Co, 1975;, pp 434-467.
12 +
Metz CE:  Basic principles of ROC analysis . Semin Nucl Med 1978;;8:283-298.
13 +
Swets JA, Pickett RM, Whitehead SF, et al:  Assessment of diagnostic technologies . Science 1979;;205:753-759.
14 +
Dorfman DD, Alf E Jr:  Maximum likelihood estimation of parameters of signal-detection theory and determination of confidence intervals: Rating method data . J Math Psych 1969;;6:487-496.
15 +
Weinstein MC, Fineberg HV (eds): Clinical Decision Analysis . Philadelphia, WB Saunders Co, 1980;, pp 121-124.
16 +
Albert A:  On the use and computation of likelihood ratios in clinical chemistry . Clin Chem 1982;;28:1113-1119.
17 +
Van der Helm HJ, Hirsche EAH:  Application of Bayes' theorem to results of quantitative clinical chemical determinations . Clin Chem 1979;;25:985-988.
18 +
Fagan TJ:  Nomogram for Bayes' theorem . N Engl J Med 1975;;293:257.
19 +
Rose CR, Murphy JG, Schwartz JS:  Performance of an index predicting the response of patients with acute bronchial asthma to intensive emergency department treatment . N Engl J Med 1984;;310:573-577.
20 +
DeDombal FT, Staniland JR, Clamp SE:  Geographical variation in disease presentation: Does it constitute a problem and can information science help? Med Decis Making 1981;; 1:59-69.
21 +
Copas JB:  Regression, prediction and shrinkage . J R Stat Soc 1983;;45:311-354.
22 +
Poses RM, Cebul RD, Collins M, et al:  The accuracy of experienced physicians' probability estimates for patients with sore throats . JAMA 1985;;254:925-929.
23 +
Rozanski A, Diamond GA, Berman D, et al:  The declining specificity of exercise radionuclide ventriculography . N Engl J Med 1983;; 309:518-522.
24 +
Sox HC:  Probability theory in the use of diagnostic tests: An introduction to critical study of the literature . Ann Intern Med 1986;; 104:60-66.
25 +
Gray R, Begg CB, Greenes RA:  Construction of receiver operating characteristic curves when disease verification is subject to selection bias . Med Decis Making 1984;;4:151-164.

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1 +
Lee YN, Terry R, Lukes RJ:  Lymph node biopsy for diagnosis: A statistical study . J Surg Oncol 1980;;14:53-60.
2 +
Zuelzer WW, Kaplan J:  The child with lymphadenopathy . Semin Hematol 1975;;12:323-334.
3 +
Greenfield S, Jordan C:  The clinical investigation of lymphadenopathy in primary care practice . JAMA 1978;;240:1388-1393.
4 +
Saltzstein SL:  The fate of patients with nondiagnostic lymph node biopsies . Surgery 1965;;58:659-662.
5 +
Sinclair S, Beckman E, Ellman L:  Biopsy of enlarged, superficial lymph nodes . JAMA 1974;; 228:602-603.
6 +
Knight PJ, Mulne AF, Vassy LE:  When is lymph node biopsy indicated in children with enlarged peripheral nodes? Pediatrics 1982;; 69:391-396.
7 +
Luscieti P, Hubschmid TH, Cottier H, et al:  Human lymph node morphology as a function of age and site . J Clin Pathol 1980;;33:454-461.
8 +
Zitelli BJ:  Neck masses in children: Adenopathy and malignant disease Pediatr Clin North Am 1981;;28:813-821.
9 +
Slap GB, Brooks JSJ, Schwartz JS:  When to perform biopsies of enlarged peripheral lymph nodes in young patients . JAMA 1984;;252:1321-1326.
10 +
International Classification of Disease, Ninth Revision, Clinical Modification , Dept of Health and Human Services publication (PHS) 80-1260. Health Care Financing Administration, 1980;, vol 3, pp 110-111.
11 +
Klecka WR:  Discriminant analysis , in Nie NH, Hull CH, Jenkins JG, et al (eds): SPSS: Statistical Package for the Social Sciences , ed 2. New York, McGraw-Hill International Book Co, 1975;, pp 434-467.
12 +
Metz CE:  Basic principles of ROC analysis . Semin Nucl Med 1978;;8:283-298.
13 +
Swets JA, Pickett RM, Whitehead SF, et al:  Assessment of diagnostic technologies . Science 1979;;205:753-759.
14 +
Dorfman DD, Alf E Jr:  Maximum likelihood estimation of parameters of signal-detection theory and determination of confidence intervals: Rating method data . J Math Psych 1969;;6:487-496.
15 +
Weinstein MC, Fineberg HV (eds): Clinical Decision Analysis . Philadelphia, WB Saunders Co, 1980;, pp 121-124.
16 +
Albert A:  On the use and computation of likelihood ratios in clinical chemistry . Clin Chem 1982;;28:1113-1119.
17 +
Van der Helm HJ, Hirsche EAH:  Application of Bayes' theorem to results of quantitative clinical chemical determinations . Clin Chem 1979;;25:985-988.
18 +
Fagan TJ:  Nomogram for Bayes' theorem . N Engl J Med 1975;;293:257.
19 +
Rose CR, Murphy JG, Schwartz JS:  Performance of an index predicting the response of patients with acute bronchial asthma to intensive emergency department treatment . N Engl J Med 1984;;310:573-577.
20 +
DeDombal FT, Staniland JR, Clamp SE:  Geographical variation in disease presentation: Does it constitute a problem and can information science help? Med Decis Making 1981;; 1:59-69.
21 +
Copas JB:  Regression, prediction and shrinkage . J R Stat Soc 1983;;45:311-354.
22 +
Poses RM, Cebul RD, Collins M, et al:  The accuracy of experienced physicians' probability estimates for patients with sore throats . JAMA 1985;;254:925-929.
23 +
Rozanski A, Diamond GA, Berman D, et al:  The declining specificity of exercise radionuclide ventriculography . N Engl J Med 1983;; 309:518-522.
24 +
Sox HC:  Probability theory in the use of diagnostic tests: An introduction to critical study of the literature . Ann Intern Med 1986;; 104:60-66.
25 +
Gray R, Begg CB, Greenes RA:  Construction of receiver operating characteristic curves when disease verification is subject to selection bias . Med Decis Making 1984;;4:151-164.

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